| NPI | 1144385410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1339) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: NM 1339) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NM 1339) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2008-02-08 |